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Originally posted by Bytemite:
The only thing I really see missing is the elderly and children. How would they fit into this program?

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We set up a program that sends every person in the US (up to a certain income level, but a fairly high one, 80k per individual let's say) a check for a percentage of their health insurance deductible. The percentage is graduated, the poor get 100% funding, all the way up to upper middle class who'd get 5% or something. For that year they can spend this money only on health care expenses that apply to the deductible. At the end of the year, if they haven't used all of the money, the remainder is their's to keep.

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Originally posted by AnthonyT:
Hello,

The public 'option' is only truly an option if you can opt out of it.

I suspect that people who wish to keep private health insurance will essentially be paying for health insurance twice: Once via taxes, and then again with what's left after taxes.

That is not, to my mind, a very good option.

--Anthony

"Liberty must not be purchased at the cost of Humanity." --Captain Robert Henner

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Originally posted by AnthonyT:
Hello,

Well, we actually do get something for that money, Kwicko. We get the public services provided by the public employees. Those employees are attracted to their position by a combination of pay and benefits.

Now, you and I can probably agree wholeheartedly that there are many public servants (and perhaps entire government agencies) that we would be happy to live without.

--Anthony

"Liberty must not be purchased at the cost of Humanity." --Captain Robert Henner

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Originally posted by SignyM:
How is this supposed to work? I know you have the idea that if people had to watch their pennies to get health care, market forces would take over and the problem would be solved. But if you can't get insurance in the first place, you have no deductible.

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And the only thing it would promote is insurance with low DEDUCTIBLES, not necessarily low premiums.

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I enjoy having 911 service and police protection and fire fighting services. I enjoy having public roads that are relatively safe and well-lit. There are many other public services I enjoy, and I am happy to pay taxes so that these services can be maintained.

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Providing health care is an important part to making sure that these services are properly staffed.

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Though, you should disabase yourself of the notion that all health care derived from public employment is some miraculous inexpensive bounty. My health coverage in public service was very much like my health coverage from private employment- the job only paid for part of it.

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Public health care will necessarily force me to pay for insurance not only for people whose services I may not care to subsidize, but also for myself and others who may not wish to partake of the service.

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The end result may be that I can no longer afford my private health plan in addition to the taxes which pay for the public 'option.' Even if I can afford it, my pocket is still being picked in a way not amenable to me.

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I apparently failed in describing the plan.... The single most pervasive problem in health care right now is runaway inflation. The normal market incentives are completely broken because we're abusing insurance.

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Insurance is supposed to be for unexpected calamities that you couldn't hope to pay for from savings. But for decades the insurance industry has encouraged us to use insurance to finance day-to-day health care expenses. This is where the incentives get screwed. An insured patient has virtually no incentive to curtail health care expenses. As long as they have coverage, they might as well shoot for the moon.

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This is obviously dysfunctional and couldn't NOT produce price inflation.

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But the insurance industry was able to manage it for several decades because they were running things more or less like a ponzi scheme. As long as they could expand their customer base, they could afford the higher prices without raising premiums that much. I'd wager they even looked at price inflation as good for their bottom line because it pushed more and more people into the insurance game, to the point we're at now where people see health insurance as the only way to afford health care.

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But think about how screwed up that is. It's like using a credit card to buy groceries and pay the bills because you can't afford them with the money you make. At some point you have to face reality and take a hard look at your budget.

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Anyway, like any ponzi scheme, once the expanding customer base dries up, you're screwed. We're in the final stages of that now. Without an expanding base, they're forced to raise premiums and cut back on benefits. (That's why they're so eager for the "individual mandate", but even that will just give them a "fix" for a few more years.)

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HMOs were supposed to solve this problem, and they actually worked for a while.

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But generations of customers weened on the idea that the "doctor/patient" relationship was sacred, balked at the idea of "bureaucrats" setting limits on their treatments

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and implementing cost saving measures. Consumer pressure, along with extensive lobbying by the AMA, goaded congress into regulating away the HMOs ability to cut costs, which meant we were back in the same boat.

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So the insurance companies (the only people in the equation with any incentive to cut costs) are stuck "negotiating" with doctors for lower prices and setting tighter limits on what they'll cover. But these sorts of things are extremely unpopular and also push up against regulatory constraints. Which brings us to my glorious plan. The point is to get the market weened off using insurance to pay for regular health care expenses.

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With the government covering the deductible, customer have little reason to go for low deductible plans (with their heavy-duty premiums), quite the opposite in fact. They'll be looking for catastrophic plans with very high deductibles (and very low premiums). And, since they're looking at the very real possibility of keeping the money covering their deductible, if they can avoid using all of it, this will effectively simulate paying "out of pocket". They'll have very real incentive to negotiate for lower prices and look for bargains.

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Once this takes hold, we'll have a growing portion of the health care market that suddenly cares a lot more about what they're spending. And I don't mean that they'll "care" because Obama says it's good for the nation. I mean that they'll "care" because it hits them in the pocketbook. When they are the direct beneficiaries of savings, and the ones to feel the loss of excessive spending, the dynamic will start to change. They'll actually ask a doctor what their office visits cost. They'll ask about cheaper options when such a thing is viable. They'll get a second opinion, not because Aunt Sally says it's a "good idea", but because they think the treatment recommended by Dr. A sounds too damned expensive. When customers start really pushing for cheaper sources of health care (which they haven't been doing for decades), I'm betting that within five years we'll not only see health care inflation halted, prices will begin to drop well below current levels.

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Originally posted by SignyM:
.. the same might be said for care providers- doctors, radiologists, anesthesiologists, testing laboratories etc. The more procedures, the more reimbursement. This happens all across the spectrum of care, from day-to-day care to catastrophic coverage to end-stage treatment/ hospice.

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However, day-to-day health care is NOT what's driving costs. In fact, day-to-day health care (in theory, anyway) is what KEEPS people healthy. There are bigger drivers in healthcare costs besides stuffy noses:

End-of-life treatment. The last six months is typically the most expensive.

Chronic illnesses of the medically uninsured treated in the ER. I read a study which showed that five patients accounted for 80% of ER costs in one hospital in a year. (I'll try to find the study because I'm ballparking the figures) These people had diabetes, mental illness, emphysema/ asthma which would reach critical levels. These people would be better off, and cost less, if treated regularly in a clinic setting.

Uncoordinated care. Mayo Clinic spends half of what other university-research hospitals spend by forming TEAMS which handle all aspects of a patient's care, not just shuffling a patient from one specialist to another.

Insurance "administrative" costs and profits, pharma profits etc.

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Again, yes, but... Other nations use single payer. The SAME DRIVER (more treatment= more reimbursement) is in place in their systems too. Nonetheless, their health care is approximately ONE HALF the cost of ours, per person.

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But the insurance industry was able to manage it for several decades because they were running things more or less like a ponzi scheme. As long as they could expand their customer base, they could afford the higher prices without raising premiums that much. I'd wager they even looked at price inflation as good for their bottom line because it pushed more and more people into the insurance game, to the point we're at now where people see health insurance as the only way to afford health care.

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But they HAVE been raising premiums! Premiums have been going up at roughly double the inflation rate for the past two decades.

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HMOs were supposed to solve this problem, and they actually worked for a while.

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Not really. I used to belong to Kaiser Permanente. But ...

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Again, yes, but... Other nations use single payer: publicly-funded, privately-provided. The SAME DRIVER (more treatment= more reimbursement) is in place in their systems too. Nonetheless, their health care is approximately ONE HALF the cost of ours, per person. So is the "misuse" of insurance REALLY the problem? Is the "broken" market system really the issue? Or is there some other factor which creates such cost pressures?

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The buzzword for that is "rationing", and mostly it's a repub scare tactic, but the point is, you'd have the state making the decisions to save money rather than the patient.

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But in the reality, I suspect the government will not have any such thing as a limited pocketbook. I suspect they will acquire as much money as they need (from us) by using the threat of inadequate health care as a penalty for not endorsing additional funding. Because they can either tax us, or print as much money as they need (another form of tax), they will not actually have any incentive to behave efficiently and well.

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Originally posted by UnabashedVixen:
There have been a lot of scare tactics used by the Republicans, saying that a system similar to Canada's would cause all sorts of decline in care, that the government would decide who gets treated and how. That's all BS.

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The buzzword for that is "rationing", and mostly it's a repub scare tactic, but the point is, you'd have the state making the decisions to save money rather than the patient.

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Um, no.

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Is our system perfect? By no means. .. [but] the vast majority of Canadians (around 85%) wouldn't trade our system, and for every horror story you've heard from here, we've heard 10 from the US.

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We're watching your debate very closely up here (we get bored for political news in the summer, as our politicians are all on the barbeque circuit).

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Originally posted by AnthonyT:

You'll also note that I never referred to socialism as 'evil.' I have only ever maintained that it is inefficient. And in fact, I believe that the more government takes control of a process, the less efficient it seems to become.

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The Canadian fellow above made me feel hopeful, but Mike, nothing you've said has inspired me with confidence.

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Not to mention the fact that if there is an efficient Canadian health care system, you can be sure that we will NOT be adopting it. We'll brew something homegrown and ungainly.

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I'm not sure what you're saying no to. I'm not saying they'd make calls on a patient-by-patient basis (though I'd honestly be a little more comfortable with that approach). No, they'd control spending through policy decisions that set blanket conditions and qualifications on who was eligible for what treatments and under what circumstances. Please correct me if that's not the case, but I'm pretty sure that's how it works in general. Or does everyone just get whatever they want?

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Originally posted by AnthonyT:

Hello,

My sincerest apologies to fellowizing a female. :-(

--Anthony

"Liberty must not be purchased at the cost of Humanity." --Captain Robert Henner

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It's just there's this pervasive idea, it seems, that under universal health care some soulless entity is deciding your fate. It's just not the case.

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But now it's a black mark against me if I ever try to get insurance on my own away from an employer. And my daughter may never be able to get private insurance under our current system

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Originally posted by SignyM:

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But now it's a black mark against me if I ever try to get insurance on my own away from an employer. And my daughter may never be able to get private insurance under our current system

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I have a duaghter with similar issues. Same problem with insurance. I HAVE to apply for SSI for her because she needs the INSURANCE. If I were assured that "no-exclusion" insurance would be available, I'd drop the SSI in a heartbeat.

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Originally posted by rue:
I would hope that the comfy people expand their thinking a little to take into account those who are pressed by necessity.

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Originally posted by Kwicko:
NCBC, you SHOULD post here more often.

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Originally posted by ncbrowncoat:
I rarely come to the RW boards but here I am. I just had to weigh in on this debate with my idea....

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Originally posted by SergeantX:

I can't get behind mandated insurance of any form, but since congress seems hell bent on cramming that down our throats, we should at least be allowed to go with a low-cost, catastrophic policy like you mentioned.

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I do not think it is my right, as a less-affluent person, to go around robbing more affluent people to pay for my medical conditions. I do not feel this way now that I am in the lower-middle class, and I did not feel this way when I was in the lower-lower class. I do not think it is my right to demand to be taken care of by others just because it benefits me to make such a demand.

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